OnlineHost:  Dr. Susan M. Lark has entered the room. 

Dearest:   My guest tonight has been a noted authority on women's 
health care and preventive medicine for over 20 years.

DR. SUSAN LARK has been on the clinical faculty of Stanford University 
Medical School, where she continues to lecture, when she isn't seeing 
patients in her private practice in Los Altos.

Dr. Susan Lark is the author of nine books in the Dr. Susan M. 
Lark "Self Help" Library for Women, among them: "Dr. Susan 
Lark's..."Estrogen Decision Self-Help Book" - "Making The Estrogen 
Decision"  -- Menopause Self-Help Book" -- "Anxiety & Stress Self-Help 
Book" and "Fibroid Tumor and Endometriosis Self Help Book."

Dr. Lark, it's a pleasure to welcome you to Power Surge. Your 
books are so *readable* -- your suggestions simple to apply. Would 
you kindly share your philosophy about the importance of 
approaching menopause holistically and what lifestyle changes 
might invariably help women get through menopause more easily? 


Dr. Susan Lark:  When I work with women patients or lecture to women 
at my workshops and seminars, I strongly emphasize the importance 
of women assessing their meno symptoms as well as their risk 
factors for conditions which become more prevalent after midlife, 
such as osteo, heart disease, and breast cancer. Interestingly 
enough, while their are multiple treatment options for meno and 
meno related conditions, such as prescription hormones, natural 
hormone therapies and nutritional therapies, only a minority of 
women chose to take prescription hormones. If a woman's symptoms 
are mild to moderate and her risk factors for conditions like 
osteo are minimal, often lifestyle based therapies such as dietary 
and nutritional supplement programs, stress reduction techniques, 
accupressure and exercise are sufficient. I always recommend that 
even women utilizing prescription hormones practice healthy 
lifestyle habits for best results. I feel strongly that each woman 
should be knowledgeable about these treatment options and initiate 
her own self care program for best results.  


Dearest:   Thank you, Dr. Lark. 


Kefrn:   Vitamins A,B,C,E, iron, xvits a miracle for my 
menorrhagia. Would cream progesterone be an additional benefit? 


Dr. Susan Lark:   Menorrhagia is a very common condition seen during 
the perimenopause because of a estrogen/progesterone imbalance 
that occurs because of an increasing tendency towards anovulatory 
cycles, where anovulatory progesterone is not produced or it's 
production is inadequate. Using progesterone cream or other forms 
of progesterone by replacing a hormone that women are no longer 
producing on a regular basis. You need to use the progesterone at 
least 10 to 12 days per month to promote a maturational effect on 
the uterine lining and thereby prevent heavy menstrual bleeding,
hyperplasia and even uterine cancer. 
              For women who are overproducing estrogen, the 
supplements that you are taking are very useful. I also usually 
recommend that my patients use one to two tablespoons of flax seed 
oil or 4 to 6 tablespoons of flax meal combined with non-dairy 
milk as a cereal. Flax seed oil and the lignans found within the 
flax seed are necessary to trigger ovulation and the production of 
progesterone within the body at midcycle. A recent University of 
Minn. study found that women using ground flax meal ovulated more 
frequently and used more progesterone than women who did not use 
the flax meal. The flax oil is available in health food stores and 
can be used as a butter substitute when added to food. Do Not Cook 
With It! In addition, it must be refrigerated. Finally, 
bioflavonoids have been shown in many research 


Kitkat4888:   I am on birth control pills. What is the easiest way 
to make the transition from them to hormone replacement & when 
should the transition be made?  


Dr. Susan Lark:   The transition is usually made around the age of 50 
give or take a few years. Drs. can check an FSH level and see if 
you're in meno (if it's elevated). You can then be switched to 
regular HRT. 


Mom350:   Does all HRT cause you to have a period? And is having 
a period necessary?


Dr. Susan Lark:   Mom 350 - No, low dose estrogen supplements may not 
produce enough buildup to the lining of the uterus. In addition, 
taking estrogen and progesterone everyday for HRT will cause the 
lining of the uterus to eventually become inactive. 


SuniKaty:   Is one-half of a .05 Estrace taken daily too small a 
dose to have any positive effect?


Dr. Susan Lark:   Dosage needs for estrogen vary greatly from woman to 
woman depending on how much estrogen your ovaries and adrenals 
continue to make after menopause. In some women very small dosages 
are enough to relieve symptoms. Higher dosages of estrogen may be 
needed in women with risk factors or conditions like osteo.


SuniKaty:   Thank you Dr. Lark



RCHCTH:   What is the 1st day of a cycle, the slightest bit of 
pink tinge or when the flow gets started?


Dr. Susan Lark:   The first day of a cycle may be either very light or 
reasonable heavy depending the estrogen build stimulation of the 
uterine lining. Women who are low estrogen producers may have 
spotting the first day, which never gets much heavier. Women who 
are high estrogen producers may bleed profusely. However, in the 
perimenopause, when estrogen production begins to decline, women 
may have a few or more days of spotting before the actual onset of 
the menstrual cycle bleeding due to the progesterone deficiency. 



MAcohen98:   Why do you think I still get flashes while taking 
prempro?


Dr. Susan Lark:   A relatively small number of women will continue to 
have hot flashes no matter what type of HRT they are on or what 
dosage they are prescribed.  These women often go off HRT because 
they find that their symptoms are actually worse on HRT. 
Otherwise, low dose hormone therapy with the persistence of hot 
flashes may necessitate increasing the dosage until symptoms are 
eliminated or switching to another type of HRT. 



MELADONNA:   Can hrt - progesterone, estriol & testosterone in a 
natural compound - give you sores in the mouth? 


Dr. Susan Lark:   I am not aware of natural HRT normally producing 
sores in the mouth. However, acid/alkaline imbalances, which often 
are aggravated at midlife can do this. Acid foods, need to be 
avoided. Stress can also aggravate this condition. 


Cocograms:   I am 51 and currently using HRT. 15 years ago, I was 
told that I have osteo, I have a lump on my neck.  I take calcium 
and the lump has not got bigger for many years. Is there anything 
I can do to get rid of the lump, like take more calcium?  


Dr. Susan Lark:   I do not know from your question what this lump is 
due to. Often lumps in the neck are swollen lymph nodes and can 
occur due to chronic and recurrent upper respiratory infections. 
They can also be muscular in origin. Calcium is only useful if in 
treating loss of bone density. 


Cocograms:   Thank you.


Catalina5:   I thought the phytoestrogens in flaxseed were in the 
seed covering -- not oil.  Correct?


Dr. Susan Lark:   Both the seed covering which contains lignans and the 
flax seed oil itself are weakly estrogenic. Flaxseeds are amazing 
in that they contain two separate sources of estrogen like 
substances. For example a 1990 study found that flaxseed oil had 
an estrogenic effect on the vaginal lining in post meno women 
(average age 59). 


Vdander:   I'm glad to hear that the amount of estrogen depends on 
risk factors. That explains a few things to me. Women in my family 
are prone to problems with the ovaries, even after hysterectomies.


JILLY:   Do women who have had a tubal ligation, seem to have 
severe meno problems?  Thanks.


Dr. Susan Lark:   Women with tubal ligations are more prone towards 
menstrual irregularity and heavy bleeding than meno related 
problems, in my experience. 


Mom350:   What about better sex life/lack of interest, I WANT it 
Back. What about DHEA?  


Dr. Susan Lark:   Lack of libido after meno is commonly seen in as many 
as one half to two thirds of women, because of declining 
testosterone, estrogen and dopamine levels. The use of 
testosterone, estrogen and dopamine precursor like phenylaline (an 
essential amino acid) can help to restore a woman's sex drive. 


Dearest:   There's a lot of confusing info out there about HRT. 
While it claims to protect women from heart disease by lowering 
LDL (bad cholesterol) levels, there's evidence that it actually 
raises triglycerides, a known factor in heart disease. How do we 
decide when there's so much conflicting information?


Dr. Susan Lark:   What you have stated is absolutely true. Women 
who are at high risk of heart disease may find that they can 
significantly reduce their risk factors for heart attacks and 
strokes by changing to a vegetarian (vegan) diet utilizing soy 
food products, other legumes, whole grains, fresh fruits and 
veggies, flax seed oil and fish that is rich in omega-3 fatty 
acids like salmon or trout - if they find they need to add meat to 
their diet. In addition, fiber supplements like guar gum and 
pectin and antioxidants like vitamin E, C and beta-carotene can 
reduce the risk of strokes and heart attacks and begin to 
eliminate the risk factors. If this is not enough, conventional 
HRT can always be added to the program. 


Dearest:  Thanks, Dr. Lark. 


SuniKaty:   Is it OK to eat large quantities of tofu and also 
take a small dose of estrace daily? (Even if overweight?)


Dr. Susan Lark:   There is no reason why phytoestrogens and 
prescription hormones can not be combined. Many women on small 
doses of estrogen, like .3 mg of premarin or premarin cream for 
vaginal atrophy or estriol, the weak natural prescription 
estrogen, often use phytoestrogens to "fill in the gaps". The type 
of oils contained within tofu do not, in my opinion, contribute to 
overweight.  Tofu is a rich source of the essential fatty acids, 
linoleic acid and linolinic acid which the body needs for healthy 
brain and nerve structure, healthy skin and mucous membranes and 
the production of beneficial prostaglandin hormones among 
benefits. I have seen women on a diet rich in essential fatty 
acids actually lose weight. However, the intake of saturated fats 
such as dairy fat, red meat fat, the saturated fats found in 
margarine are not readily used by the body and more easily 
contribute to overweight. 


SuniKaty:   Thank you!


RCHCTH:   How long does it take the body to adjust to an herb, 
for example, Black Cohosh/runs?  


Dr. Susan Lark:   Women may begin to see symptom relief of hot flashes 
and mood swings within a few days to a week with black cohosh. 
Side effects are much less of an issue than with prescription 
hormones. 


MELADONNA:   What number is a low estrogen reading? What is a 
"good" number? 


Dr. Susan Lark:   I always look at my medical charts for lab tests 
normals and I do not have those charts with me. However FSH is 
considered abnormal above 30. This can vary from lab to lab.


Catalina5:   What is your opinion of "the zone" type of diet----
30%,30%, 40% ?  


Dr. Susan Lark:   The Zone diet, which tends to be highly acid forming 
is workable for people who have strong liver and pancreatic 
functions and are producing enough digestive enzymes, bile, etc. 
to digest, absorb and assimilate a highly acidic, protein emphasis 
diet. In addition, the buffering system of the body which consists 
of the pancreas, lungs, bones and blood buffers need to be strong 
enough to neutralize the dietary acids. Both the digestive 
function and acid/alkaline of most people by midlife is no longer 
functioning at the levels needed to handle the Zone diet. For the 
rest of the population a more alkaline based, vegetarian based 
diet is preferable. However, a small percent of the population 
will do very well on the Zone diet through old age. 


Mwill4751:   I am concerned with my 40 excess pounds. Will they 
affect menopausal symptoms? 


Dr. Susan Lark:   The 40 excess pounds will most likely cause you to be 
a high estrogen producer. The more body fat that you carry, the 
more estrone (an intermediate potency estrogen) you will produce 
in your fat cells produced from a precursor hormone made by the 
adrenal glands. The good news is that you are less likely to have 
hot flashes, vaginal atrophy or weak bones. The bad news is that 
this can increase your risk of heavy menstrual bleeding during the 
perimenopause as well as uterine and breast cancer and even gall 
bladder disease.  


Dearest:   Dr. Lark, thank you for joining us in Power Surge and 
fielding our questions about menopause and related midlife health 
issues.

Anyone interested in reading Dr. Susan Lark's wonderful collection 
of "self-help" books can find them on my Reading List.

Specifically, a few are: "Estrogen Decision Self-Help Book" - 
"Making The Estrogen Decision"  -- Menopause Self-Help Book" -- 
"Anxiety & Stress Self-Help Book" and 
"Fibroid Tumor and Endometriosis Self Help Book.".


Dr. Susan Lark: Thank you for having me. 



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aka Alice Stamm
Power Surge
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